In-vitro-Maturation - Indikationen, Risiken und Chancen einer neuen assistierten Reproduktionstechnik

Zusammenfassung

Das Risiko einer ovariellen Überstimulation und die hohen Kosten der Gonadotropine bei der konventionellen In-vitro-Fertilisation (IVF) haben zu der Entwicklung der In-vitro-Maturation (IVM) geführt, die die Entnahme unreifer Eizellen aus dem Ovar und die nachfolgende Maturation in vitro ermöglicht. Diese Technik erfordert keine oder nur geringe Dosen von Gonadotropinen und vermeidet somit das Risiko der Überstimulation. Obwohl in den ersten Jahren angenommen wurde, dass die IVM die konventionelle IVF in Zukunft ersetzen würde, hat sich inzwischen gezeigt, dass ein uneingeschränkter Einsatz derzeit nicht sinnvoll ist. Sinnvoll einsetzbar ist die IVM derzeit insbesondere bei Patientinnen im Z. n. einer hochgradigen ovariellen Überstimulation bei einer IVF-Behandlung sowie bei Patientinnen mit polyzystischen Ovarien. Die Gründe für eine Begrenzung der Indikationsbereiche liegen insbesondere in den bisher nur unzulänglich untersuchten Risiken der Maturation in vitro für die Entwicklung von Imprinting-Defekten und in der geringeren Effektivität der IVM im Vergleich zur konventionellen IVF. In dieser Arbeit sollen die Grundlagen der IVM, deren Risiken, Chancen und Indikationsbereiche dargestellt und im Kontext mit den Erfahrungen der Autoren diskutiert werden.

Abstract

The risk of an ovarian hyperstimulation syndrome and the high costs of gonadotrophins, used in conventional in vitro fertilisation (IVF), have led to the development of a new technique, called in vitro maturation (IVM), in which immature oocytes can be obtained without stimulation by exogenous gonadotrophins. This technique requires none or very low amounts of gonadotrophins and therefore avoids the risk of an ovarian hyperstimulation syndrome. Even though the indication for the use of IVM is still under discussion, its use in patients who had suffered from an ovarian hyperstimulation syndrome in previous IVF treatments and in patients with polycystic ovary syndrome is widely accepted. The reason for the ongoing controversial discussion about the general use of IVM in infertile patients is the limited knowledge on the risk of the development of imprinting defects and the lower efficiency of IVM in comparison to conventional IVF. This paper provides basic knowledge on IVM, it discusses critically the chances and risks of this new techniques and it describes our own experience of IVM in Heidelberg, Germany.

Schlüsselwörter

In‐vitro‐Maturation - Infertilität - Oozyte - polyzystisches Ovarsyndrom

Key words

in vitro maturation - infertility - oocyte - polycystic ovary syndrome

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